First-Year Performance: Students with Disabilities Transitioning to College from High School

Laws such as the Individuals with Disabilities Act (IDEA), Americans with Disabilities Act (ADA), Americans with Disabilities Act Amendments Act (Amendments Act), and Section 504 of the Rehabilitation Act of 1973 (Section 504) govern the responsibilities of both secondary schools and postsecondary institutions in regards to students with learning disabilities. With an approximate 34.5% of students with learning disabilities in secondary schools within the United States transitioning into higher education in 2005, the transition from secondary school to a college or university can be a time full of stress, new experiences, and confusion for students with learning disabilities. The purpose of this literature review was to determine what factors lead some first-year students with documented learning disabilities to not seek reasonable academic accommodations from an institution’s disability services office. Research indicated that approximately 11% of students enrolled at postsecondary institutions have disclosed having a disability to their institution. Prior to leaving a secondary school, developing proper transition skills, such as self-advocacy or self-determination, are critical for a successful transition. To enhance the transition process, secondary schools and postsecondary institutions should work together to educate students and their families on the student responsibilities for being eligible to receive academic accommodations. Through the collaboration and the development of transition skills, students with learning disabilities will be more likely to seek services and be more academically successful

Education and support needs during recovery in acute respiratory distress syndrome survivors

Abstract Introduction There is a limited understanding of the long-term needs of survivors of the acute respiratory distress syndrome (ARDS) as they recover from their episode of critical illness. The Timing it Right (TIR) framework, which emphasizes ARDS survivors' journey from the ICU through to community re-integration, may provide a valuable construct to explore the support needs of ARDS survivors during their recovery. Methods Twenty-five ARDS survivors participated in qualitative interviews examining their needs for educational, emotional and tangible support for each phase of the TIR framework. Transcripts were analyzed using framework methodology. Results ARDS survivors' support needs varied across the illness trajectory. During the ICU stay, survivors were generally too ill to require information. The transfer to the general ward was characterized by anxiety surrounding decreased surveillance and concern for future health and treatment. Information needs focused on the events surrounding the acute illness, while physical and emotional needs revolved around physical therapy and psychological support for depression and anxiety. As patients were preparing for hospital discharge, they expressed a desire for specific information about the recovery and rehabilitation process following an episode of ARDS (e.g., outpatient physiotherapy, long-term sequela of the illness). Once in the community, survivors wanted guidance on home care, secondary prevention, and ARDS support groups. Conclusions Our findings support the need for future educational and support interventions to meet the changing needs of ARDS survivors during their recovery

A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic

Abstract Introduction The objective of this pilot study was to assess the usability of the draft Ontario triage protocol, to estimate its potential impact on patient outcomes, and ability to increase resource availability based on a retrospective cohort of critically ill patients cared for during a non-pandemic period. Methods Triage officers applied the protocol prospectively to 2 retrospective cohorts of patients admitted to 2 academic medical/surgical ICUs during an 8 week period of peak occupancy. Each patient was assigned a treatment priority (red -- 'highest', yellow -- 'intermediate', green -- 'discharge to ward', or blue/black -- 'expectant') by the triage officers at 3 separate time points (at the time of admission to the ICU, 48, and 120 hours post admission). Results Overall, triage officers were either confident or very confident in 68.4% of their scores; arbitration was required in 54.9% of cases. Application of the triage protocol would potentially decrease the number of required ventilator days by 49.3% (568 days) and decrease the total ICU days by 52.6% (895 days). On the triage protocol at ICU admission the survival rate in the red (93.7%) and yellow (62.5%) categories were significantly higher then that of the blue category (24.6%) with associated P values of < 0.0001 and 0.0003 respectively. Further, the survival rate of the red group was significantly higher than the overall survival rate of 70.9% observed in the cohort (P < 0.0001). At 48 and 120 hours, survival rates in the blue group increased but remained lower then the red or yellow groups. Conclusions Refinement of the triage protocol and implementation is required prior to future study, including improved training of triage officers, and protocol modification to minimize the exclusion from critical care of patients who may in fact benefit. However, our results suggest that the triage protocol can help to direct resources to patients who are most likely to benefit, and help to decrease the demands on critical care resources, thereby making available more resources to treat other critically ill patients

A Probabilistic Approach to the Spatial Variability of Ground Properties in the Design of Urban Deep Excavation

Uncertainty in ground datasets often stems from spatial variability of soil parameters and changing groundwater regimes. In urban settings and where engineering ground interventions need to have minimum and well-anticipated ground movements, uncertainty in ground data leads to uncertain analysis, with substantial unwelcomed economical and safety implications. A probabilistic random set finite element modelling (RSFEM) approach is used to revisit the stability and serviceability of a 27 m deep submerged soil nailed excavation built into a cemented soil profile, using a variable water level and soil shear strength. Variation of a suite of index parameters, including mobilized working loads and moments in facing and soil inclusion elements, as well as stability and serviceability of facing and the integrated support system, are derived and contrasted with field monitoring data and deterministic FE modelling outputs. The validated model is then deployed to test the viability of using independent hydraulic actions as stochastic variables as an alternative to dependent hydraulic actions and soil shear strength. The achieved results suggest that utilizing cohesion as a stochastic variable alongside the water level predicts system uncertainty reasonably well for both actions and material response; substituting the hydraulic gradient produces a conservative probability range for the action response only

Impact Assessment of the Village Seed Bank (VSB) program for chickpea, groundnut and pigeonpea in the Central Dry Zone of Myanmar, focusing on the production, distribution, productivity and profitability of seed of improved cultivars, Research Report No 76

A major objective of the Australian Centre for International Agricultural Research (ACIAR)-funded MyPulses project in Myanmar was the development of improved, high-yielding varieties of pigeonpea, groundnut and chickpea through breeding and selection and their widespread adoption by farmers of the Central Dry Zone (CDZ). The village seed bank (VSB) model was implemented by the Department of Agriculture (DoA) with backstopping from MyPulses partner International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) in the 2015–16 season, then expanded during 2016–17 and 2017–18. During the three years of the program, a total of 1,343 VSB farmers from 495 villages associated with 104 townships across the CDZ obtained good quality, improved cultivar seeds directly from the DoA. This impact assessment survey was commissioned to examine the extent to which the VSB program was successful in facilitating the spread and adoption of new, improved legume cultivars as well as the productivity and economic benefits of those cultivars. Since it would have been impossible to get feedback about the program from all the VSB farmers, 182 of them from 41 villages were selected at random for the survey..

Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction (HARP-2) trial : study protocol for a randomized controlled trial

Acute lung injury (ALI) is a common devastating clinical syndrome characterized by life-threatening respiratory failure requiring mechanical ventilation and multiple organ failure. There are in vitro, animal studies and pre-clinical data suggesting that statins may be beneficial in ALI. The Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial is a multicenter, prospective, randomized, allocation concealed, double-blind, placebo-controlled clinical trial which aims to test the hypothesis that treatment with simvastatin will improve clinical outcomes in patients with ALI

Study protocol: The Improving Care of Acute Lung Injury Patients (ICAP) study

INTRODUCTION: The short-term mortality benefit of lower tidal volume ventilation (LTVV) for patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has been demonstrated in a large, multi-center randomized trial. However, the impact of LTVV and other critical care therapies on the longer-term outcomes of ALI/ARDS survivors remains uncertain. The Improving Care of ALI Patients (ICAP) study is a multi-site, prospective cohort study that aims to evaluate the longer-term outcomes of ALI/ARDS survivors with a particular focus on the effect of LTVV and other critical care therapies. METHODS: Consecutive mechanically ventilated ALI/ARDS patients from 11 intensive care units (ICUs) at four hospitals in the city of Baltimore, MD, USA, will be enrolled in a prospective cohort study. Exposures (patient-based, clinical management, and ICU organizational) will be comprehensively collected both at baseline and throughout patients' ICU stay. Outcomes, including mortality, organ impairment, functional status, and quality of life, will be assessed with the use of standardized surveys and testing at 3, 6, 12, and 24 months after ALI/ARDS diagnosis. A multi-faceted retention strategy will be used to minimize participant loss to follow-up. RESULTS: On the basis of the historical incidence of ALI/ARDS at the study sites, we expect to enroll 520 patients over two years. This projected sample size is more than double that of any published study of long-term outcomes in ALI/ARDS survivors, providing 86% power to detect a relative mortality hazard of 0.70 in patients receiving higher versus lower exposure to LTVV. The projected sample size also provides sufficient power to evaluate the association between a variety of other exposure and outcome variables, including quality of life. CONCLUSION: The ICAP study is a novel, prospective cohort study that will build on previous critical care research to improve our understanding of the longer-term impact of ALI/ARDS, LTVV and other aspects of critical care management. Given the paucity of information about the impact of interventions on long-term outcomes for survivors of critical illness, this study can provide important information to inform clinical practice

The Effect of Pulmonary Artery Catheter Use on Costs and Long-Term Outcomes of Acute Lung Injury

Background: The pulmonary artery catheter (PAC) remains widely used in acute lung injury (ALI) despite known complications and little evidence of improved short-term mortality. Concurrent with NHLBI ARDS Clinical Trials Network Fluid and Catheters Treatment Trial (FACTT), we conducted a prospectively-defined comparison of healthcare costs and long-term outcomes for care with a PAC vs. central venous catheter (CVC). We explored if use of the PAC in ALI is justified by a beneficial cost-effectiveness profile. Methods: We obtained detailed bills for the initial hospitalization. We interviewed survivors using the Health Utilities Index Mark 2 questionnaire at 2, 6, 9 and 12 m to determine quality of life (QOL) and post-discharge resource use. Outcomes beyond 12 m were estimated from federal databases. Incremental costs and outcomes were generated using MonteCarlo simulation. Results: Of 1001 subjects enrolled in FACTT, 774 (86%) were eligible for long-term follow-up and 655 (85%) consented. Hospital costs were similar for the PAC and CVC groups ($96.8k vs.$89.2k, p = 0.38). Post-discharge to 12 m costs were higher for PAC subjects ($61.1k vs. 45.4k, p = 0.03). One-year mortality and QOL among survivors were similar in PAC and CVC groups (mortality: 35.6$14.4k and mean loss of 0.3 quality-adjusted life years (QALYs)) and a 94.2% probability of being higher than the $100k/QALY willingness-to-pay threshold. Conclusion: PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI. Trial Registration: www.clinicaltrials.gov NCT00234767. © 2011 Clermont et al